INTRODUCTION TO ANESTHESIOLOGYDEPARTMENT OF ANESTHESIOLOGYDr. HASAN SADIKIN HOSPITALPADJADJARAN UNIVERSITY

Anestesiologi

cabang / disiplin ilmu kedokteran

ruang lingkup (

1. Pendidikan : - perawat - mahasiswa kedokteran - dokter ( spesialis - dokter spesialis lain - dokter spesialis anestesi ( super spesialis - awam

2. Penelitian & Pengembangan

3. Pelayanan Anestesiologi - Anestesia & Analgesia - Resusitasi - Intensive Care Unit ( Intensive Care Medicine - Terapi inhalasi - Penanggulangan nyeri

ANESTESIHILANGNYA KESADARANSENSASIRASA PANAS-DINGINPERABAANKEDUDUKAN TUBUHNARKOSEANESTESI + ANALGESIANESTESIOLOGICabang ilmu kedokteranPemberian anestesi + analgesiMengawasi menunjang faal-faal penderita dari stres operasiDan lain-lain

PRINSIP BLOKADE ANESTESIA DAN ANALGESIALOKASI BLOK

1,2,3:- REGIONAL BLOCK4 : - GENERAL ANESTESIIMPULS PATHWAY

S E J A R A H2250 SM : Babilonia, Hyoscyamus Niger Gigi1500 Sm : Troya OpiumHerodotus : Cannabis Indica (Mariuana)Abad 13 : Theodorico Dr.Borgogni Slaap SponsSpons TidurNicolaas Praerositus : Ypnoticon OpiumChina Hashish (C. Indica)Yunani Beladona AlkaloidAssyria Mencekik Tidak Sadar SirkumsisiAbad 17-18 : Morphin, ScopolaminAbad 19 : Alkohol

16 Oktober 1846William Thomas Green Morton Drg demonstrasi Ether di Massachusetts General Hospital Boston-USA ruang Ether Dome .Dr. Crawford W. Long 1842 (tidak diumumkan) Georgia Penderita James M. Venable Ether operasi tumor di leherDrg. Horace Wells N2O zat gelak dilakukan oleh Colton demonstrasi di Harvard Med School + Prof. John Collins gagal hadir Charles J. Jackson (ahli kimia) + Morton

Demonstrasi ahli bedah :- Morton + Jackson - Waren - Henry J. Bigelow Ether Berhasil21 Nop 1846 : Oliver Wendell Holmes

Istilah AnestesiKongres Amerika : sulit menentukan siapa pemenang hadiah penemu anestesi tsb.Akhirnya :- Long meninggal mendadak - Wells bunuh diri- Morton + - Apoplexia- Jackson gilaMorton

Tugas Anestesiologi

1. Mengelola ( menghilangkan : Rasa sakit / nyeri, rasa takut pada persalinan, pembedahan dan tindakan medik lainnya, baik sebelum, selama dan sesudahnya.

2. Mengawasi dan menunjang fungsi-fungsi vital penderita yang mengalami stres pembedahan dan pemberian anestesi.

3. Mengelola penderita tidak sadar oleh karena sebab apapun.

4. Mengelola penderita yang mengidap masalah nyeri

5. Mengelola masalah resusitasi.

6. Mengelola terapi pernapasan.

7. Mengelola berbagai gangguan cairan, elektrolit dan metabolit.

Table 1-1 Definition of the practice of anesthesiology

1. Assesment, consultation and preparation of patients for anesthesia.

2. Rendering patients insensible to pain during surgical, obstetric, therapeutic and diagnostic procedures.

3. Monitoring and restoring homeostasis in perioperative and critically ill patients.

4. Diagnosing and treating painful syndromes.

5. Management and teaching of cardiac and pulmonary resuscitation.

6. Evaluating respiratoryfunction and applying respiratory therapy.

7. Teaching, supervising and evaluating the performance of medical and paramedical personel involved in anesthesia, respiratory care and critical care.

8. Conducting research at the basic and clinical science levels to explain and improve the care of patients in terms of physiologic function and drug response.

9. Involvement in the administration of hospitals, medical schools and outpatient facilities necessary to implement these responsibilities.

Adapted from the revised definition of the American Board of Anesthesiology, 1989

Bidang Ilmu Yang Dipelajari

1. Fisika

2. Anatomi

3. Fisiologi

4. Farmakologi

5. Klinik umum

6. Klinik khusus

7. Keterampilan.

Risiko tindakanPraktek anestesiMemberi fasilitasBukan pengobatanTidak sakitRelaksasiTidur tidak sadarRisiko tindakan

Risiko ( Praktek anestesi

meliputi :

1. Pemberian berbagai Obat yang sangat poten ( kuat )

2. Mengerjakan tindakan yang memerlukan Kemampuan tehnik ( ketrampilan

3. Memakai berbagai Alat Anestesi

4. Memakai berbagai Alat monitor ( memantau

Risiko ( Karena :

1. Berhubungan dengan status fisik penderita

2. Pembedahan : rasa sakit, gangguan nafas, trombosis, emboli, dll

3. Pemakaian obat-obatan

4. Prosedur Anestesi

5. Pemakaian alat

Table 1-9. Risks of Anesthesia

Less Serious Risks

Nausea and vomiting

Bruising or superficial thrombophlebitis at the intravenous acces site

Sore throat

Dental injury

Corneal abrasion

Headache

More Serious Risks

Peripheral neuropathy (ulnar neuropathy most common)

Cardiac dysrhytmias

Myocardial iinfarction

Atelectasis/pneumonia

Renal or hepatic insufficiency

Stroke

Allergic drug reactions

Malignant hyperthermia

Blood reactions

Mortality

Table 9-7. Physical Status Classification of the American Society of Anesthesiologists (ASA)

Status

ASA Class 1

ASA Class 2

ASA Class 3

Disease State

No organic, physiologic, biochemical or psychiatric disturbance.

Mild to moderate systemic disturbance that may not be related to the reason for surgery.

Examples: Heart disease that only slightly limits physical activity, essential hypertension, diabetes mellitus, anemia, extremes of age, morbid obesity, chronic bronchitis.

Severe systemic disturbance that may or may not be related to the reason for surgery.

Examples: Heart disease that limits activity, poorly controlled essential hypertension, diabetes mellitus with vascular complications, chronic pulmonary disease that limits activity, angina pectoris, history of prior myocardial infarction.

(From information in American Society of Anesthesiologists. New classification of physical status Anesthesiology 1963; 24: 111.)

Status

ASA Class 4

ASA Class 5

Emergency Operation (E)

Disease State

Severe systemic disturbance that is life-threatening with or without surgery.

Examples: Congestive heart failure, persistent angina pectoris, advanced pulmonary renal or hepatic dysfunction.

Moribund patient who has little chance of survival but is submitted to surgery as a last resort (resuscitative effort).

Examples: Uncontrolled hemorrhage as from a ruptured abdominal aneurysm, cerebral trauma, pulmonary embolus.

Any patient in whom an emergency operation is required.

Examples: An otherwise healthy 30-year-old female who requires a dilatation and curettage for moderate but persistent hemorrhage (ASA Class 1 E).

Table 9-1 Perioperative Events that Should be Discussed

with the Patient Preoperatively

Preoperative insomnia and medication available for its treatment

Time, route of administration and expected effects from the preoperative medication

Time of anticipated transport to operating room for surgery

Anticipated duration of surgery

Awakening after surgery in the recovery room

Likely presence of catheters on awakening (tracheal, gastric, bladder, venous, arterial)

Time of expected return to hospital room after surgery

Magnitude of post operative discomfort and methods available for its treatment

Insidence o postoperative nausea and vomiting

Table 9-8 Considerations that Determine the

Technique of Anesthesia

Co-existing disease that may or may not be related to the reason for surgery

Site of surgery

Body position of patient during surgery

Elective or emergency surgery

Likelihood of the presence of increased amounts of gastric contents

Age of patient

Preference of patient

General Considerations.1. Preanesthetic Preparation of the patient2. Choice of Anesthesia3. Preanesthesia Medication4. Medicolegal Aspects of Anesthesia5. Cleaning and Sterilization of the Anesthesia Equipment6. Monitoring During Anesthesia and Postanesthesia Period

7. Electrocardiography8. Cardiac Arrest and Cardiopulmonary Resuscitation9. The Anesthesia Machine10. General Anesthesia11. Intravenous Anesthesia12. Muscle Relaxants13. Laryngoscopy an Endotracheal Intubation14. Local and Regional Anesthesia15. Spinal Anesthesia16. Lumbar Epidural and Caudal Anesthesia

17. Regional Nerve Block Anesthesia18. Vasopressor and Adrenergic Blocking Agents19. Hypotensive Techniques and Induced Hypothermia20. Intravenous Fluid Therapy21. Blood Transfusions22. Liver and Anesthesia23. The Recovery Room and Intensive Care Unit24. Blood Gases: Acid-Base Balance and Oxygen Transfer25. Respiratory Therapy

26. Chest Physiotherapy27. Respiration and Respiratory Care28. Diabetes and Anesthesia29. Pollution, Fires, Explosions, and Electrical Hazards30. Complications During Anesthesia and the Recovery Periode

Special Anesthesia Problems in Surgical Specialities1. Anesthesia in Thoracic Surgery2. Anesthesia in Cardiac Surgery3. Anesthesia in Neurosurgery4. Anesthesia in Surgery for Endocrine Disoders5. Anesthesia and Analgesia in Obstetrics and Gynecology6. Pediatric Anesthesia

7. Anesthesia for Orthopedic Procedures8. Dental Anesthesia9. Anesthesia in Ophthalmology10. Anesthesia in Otolaryngology11. Anesthesia in Urologic Surgery12. Anesthesia for Outpatient Surgery13. Anesthesia for Emergency Surgery14. Invasive Hemodynamic Monitoring

Sepuluh prinsip amanat (ten commandments)

1. Janganlah bagaimanapun juga mengakibatkan penderita mengalami hipoksia/anoksia.

2. Jalan pernafasan penderita harus dijaga selalu aman dan bebas.

3. Jangan memberikan anestesia kepada penderita tanpa izinnya dan janganlah antara resiko dan hasil tindakan anestesi tidak ada keseimbangan yang menguntungkan.

4. Janganlah menyalahgunakan waktu dari orang lain dengan memperlambat program/rencana pembedahan.

5. Janganlah memberikan anestesi tanpa membuat laporan tertulis (medical record).

6. Semua peralatan harus dipersiapkan dengan rapi dan bersih serta lengkap sesuai standard.

7. Tubuh penderita harus dilindungi terhadap pengaruh-pengaruh yang merugikan selama pembedahan (perioperatif) karena penderita tidak sadar, maka andalah yang bertanggung jawab terhadap keselamatannya.

8. Janganlah penderita anda diserahkan kepada pihak lain jika belum stabil dan masih membahayakan.

9. Janganlah memberikan anestesia dengan tehnik-tehnik dan obat-obat yang tidak dikuasai oleh anda.

10. Dalam keadaan bagaimanapun anda adalah seorang spesialis klinik yang mengutamakan kepentingan penderita diatas kepentingan lainnya.